Preterm Labor
Preterm Labor
Six to eight percent of all babies born arrive before 37 weeks’ gestation. These small numbers, however, account for 75 percent of all the neonatal deaths – a significant statistic. It costs as much to care for 5 preterm babies as it does 150 pregnant women. Everyone agrees that prevention is the best approach since Mother Nature provides the best incubator. But this is easier said than done.
An Obstetrical Stew
It’s extremely difficult to prevent something when you aren’t sure of the exact cause, as in 50 to 60 percent of preterm labors. The current strategy is to identify – in advance those women most at risk for preterm labor. A look at a risk-assessment guide reveals an obstetrical stew of social, physical, and pregnancy factors that contribute to preterm labor. The following is a sample list.
Major factors for preterm labor:
Previous preterm labor
Multiple pregnancy (twins or more)
Abdominal surgery during pregnancy
Two second-trimester abortions
Cervix less than 1 cm long
Cervix dilated more than 1 cm
DES daughter
Cone biopsy of cervix
Incompetent cervix
Irritable uterus
Polyhydramnios (excessive amniotic fluid)
Uterine anomaly (double uterus)
Minor factors for preterm labor:
Bleeding after 12 weeks
One abortion in the second trimester
Three or more first-trimester elective abortions
Febrile (fever) illness
Pyelonephritis (kidney infection)
More than 10 cigarettes per day
Prevention
The earlier preterm labor is diagnosed, the sooner treatment can begin. Once the cervix has started to dilate, it’s difficult to stop the progress of labor for very long. Intensive education of women in the high-risk group is one method being used to prevent preterm labor. The women are shown how to assess themselves for signs of preterm labor. The education is reinforced by frequent telephone contact with nurses who provide support and information.
Ambulatory home monitoring is an investigational technique that may help identify pre term labor. The woman wears a uterine contraction monitor several times a day. The recorded contractions are transmitted by phone to a central unit where doctors or nurses evaluate the strip. Some feel that the home monitoring system is effective, but others feel that education and self-assessment by the pregnant woman combined with frequent nurse contact work as well and are also less expensive. Time will tell.
What’s Cooking: Symptoms
Symptoms of preterm labor are often very subtle; they may go unrecognized until the cervix has dilated. You can suspect preterm labor if you have:
- An increase in your usual clear, mucous, vaginal discharge
- Noticeable tightening of your uterus, every 10 minutes or less
- Backache different from the type you usually have
- Feeling of pressure in your pelvis
Urinary tract infections are a common cause of pre term labor symptoms. Call your doctor if you have one or “more symptoms (frequency and burning on urination). It’s easier to check it out than to deal with a preterm baby in the neonatal intensive care unit (NICU) for a month or two.
Treatment-Your Interventions
If you experience uterine contractions before 37 weeks of your pregnancy, lie on your left side and drink a quart of water. The combination of rest and fluids often quiets the irritable uterus. Call your doctor and tell her how often your contractions are occurring and what you’re doing to quiet your uterus.
Treatment- Your Doctor’s
If contractions continue in spite of your interventions, hospitalization is required to observe and treat preterm labor. Half the women treated will respond to bedrest on the left side and an IV to increase their fluid level (hydration). The fetal monitor documents the uterine activity and ensures that the baby is doing well. If after an hour or two the contractions are getting closer and/or the cervix is changing, the decision to try to stop labor has to be made. Labor usually won’t be stopped if:
- You’re 35 weeks or more pregnant
- The baby’s lungs are mature
- You’re 4 or more centimeters dilated
- Your bag of water has ruptured
Contraindications to suppressing labor include fetal distress, poorly controlled diabetes, severe preeclampsia, intrauterine infection, and bleeding.
Several drugs are used to stop labor if you’re between 26 and 35 weeks pregnant. They buy time to allow the baby’s lungs to mature. The more your cervix is dilated, the less time you can buy. The decision to use the drugs rests with you and your doctor.
If you’re less than 34 weeks pregnant and your hospital doesn’t have an NICU, you’ll probably be transferred to a hospital that can provide the expert care your baby needs. This is in the best interests of your baby. If the receiving hospital has a highly trained transport team, you may be allowed to deliver in your hospital. After delivery, your baby is then transferred.
The Crisis
The delivery of a preterm baby precipitates a major emotional and financial crisis. Important developmental tasks have been interrupted. You’re plunged into motherhood before you’re emotionally ready-you have no time to savor the anticipation. You have to work through the formidable emotions of disappointment and guilt. Disappointment is painful and acute-you didn’t have your fantasy-perfect birth experience. Instead of a picture-perfect, full term baby, your preemie is skinny, red, wrinkled, and frighteningly fragile looking.
Disappointment is minor compared to the guilt you feel. You’re convinced somehow that you’re responsible for your baby being born early. Emotionally, you have a lot of grieving to complete. You find yourself stumbling through the grieving process with stops along the way. Anger follows shock and can be directed outwardly to those around you or inwardly expressed as depression. Anger comes from fear. Communicate your feelings and fears to each other, your doctor, and the nurses caring for you and your baby.
Then, there’s your baby. Instead of euphoria, there’s fear for the fate of your very little new one. You’re expected to begin the attaching, loving process when there may be no guarantees she’ll survive. You may try to protect yourself, after all you’ve been through, by delaying the attachment process. You wonder if you’ll have to say goodbye before you really have the chance to say hello. The situation can seem overwhelming. What do you do now?
Coping
You and your husband need as much love and support as your new baby does. This isn’t a time to tough it out alone. Gather around you all the emotional support you can. Use the hospital social worker, chaplain, or other professional to help you work through that difficult but necessary grieving and adjustment process.
The development of the NICU has had a tremendous impact on the survival rates for the very pre term baby. Babies as young as 28 weeks, in the hands of a neonatologist and highly trained nurses, have very good survival rates.
The personnel in the NICU know the value of having you touch, spend time with, and nurture your baby right from the start. Liberal visiting hours provide the opportunity to hold and cuddle your baby. You can still develop that important attachment. It won’t take long before you no longer notice the tubes and machines. You only have eyes for your “little one” as he grows into that regular-sized baby you expected.